Ivermectin debate calls for good science and high professional ideals

 

Prevention of Covid-19 is a serious business. Arguably all our efforts today are directed towards performing different levels of prevention to stop the spread of this disease. But many fail to realise that prevention itself has many complex layers that we as individuals are often engaged in, but simply not aware of.

When we talk about prevention, most of us are commonly referring to primary prevention – what you do to prevent a condition or disease from ever afflicting you, such as by taking regular exercise to prevent a heart attack, or diabetes.

In the Covid-19 context, this refers to social distancing, masking and other measures including vaccination which aims to prevent individuals from ever getting infected.

Secondary prevention, on the other hand, is about getting individuals to detect their disease or condition in early stages, so that they can subsequently do something to prevent it from getting worse.

An example of this would be how we go for cancer screening to detect cancer early so that it can be treated. For Covid-19, a form of secondary prevention is to have a nose or throat swab and subsequently assessing it via RTK antigen or PCR tests for detection of disease.

The last level of prevention is tertiary prevention, which aims to reduce the impact of the disease or condition that has already afflicted an individual which are usually of a long-term nature.

This involves rehabilitation programmes and chronic disease management programmes. In terms of Covid-19, this is now an evolving issue with programmes being developed and implemented as we see more and more individuals with post-infection “long Covid syndrome”.

Secret remedies and potions

The controversies surrounding the prevention of different diseases or conditions are not new. Every house has a secret remedy to ward off some illness or other; and some have become “common myths”.

I recall when I had dengue, there were some friends and family members who swore that I would only get better after having frog porridge from a certain shop in the Klang Valley!

The clear and present danger from Covid-19, however, has made prevention of the disease become something that has been in the public eye quite a lot. Everyone has some thought on what prevents the disease, and has diligently been following their own belief with religious fervour.

What’s concerning for the public is that at the same time, there are those with the influence and resources who have often advocated or carried out prevention practices which may have limited evidence of effectiveness at best.

Controversial cures

The most recent example of this was mass sanitisation of public areas to prevent Covid-19 which created a lot of controversy since both local and international medical and scientific experts determined that this was ineffective and a waste of resources.

The latest controversy in Covid-19 prevention is Ivermectin, an old drug used to treat many types of parasite infections in humans, and also used in veterinary or animal medicine to treat worm infestations.

Recently, Ivermectin was publicly touted as being effective for prevention of Covid-19. The drug’s proponents called for it to be used for prevention and treatment of Covid-19. Just a few days ago, some organisations even lodged police reports against the health ministry for allegedly preventing this drug from being used.

Well, here’s the problem. The evidence promoting the effectiveness of Ivermectin for prevention and treatment of Covid-19 is limited and nowhere near the levels of rigorousness needed to approve it for such usage.

Questions unanswered

More so, the evidence currently available is so mixed and cannot definitely explain in concrete terms important questions such as :

i) Who should be taking the medication (whether to be utilised as prevention, or as treatment)

ii) What stages of disease should be using the medication (whether to be utilised in early stages of disease; between what day to what day)

iii) Dose or duration of treatment (how much to be taken for how long)

iv) Safety in different populations (can children take it, or pregnant women; or even individuals with different chronic diseases)

Research is ongoing on this in many different countries; and even Oxford University as well as the health ministry have announced the onset of well-designed clinical trials designed to definitely determine whether Ivermectin is effective for use against Covid-19.

Championed by post-truth groups

The polarisation over the use of Ivermectin has also raised some conflict among healthcare professionals themselves. Some have been advocating loudly for it to be used immediately in the prevention and treatment of Covid-19 in Malaysia, and recently one practitioner even received a visit from enforcement officials due to allegedly providing the medicine to patients.

On the other hand, established healthcare institutions globally, including the World Health Organization and Food and Drug Administration, as well as our health ministry; and most of the mainstream medical fraternity have stayed consistent to the message of: if it is tested and found to be effective, then the medication can and should be utilised. But until then, it should remain off-limits as its efficacy and safety have not been tested and vouched for.

Ivermectin is unfortunately the newest among medicines that have been championed by “post-truth” groups who have gone from strength to strength in the pandemic.

Around this same time last year, hydroxychloroquine (HCQ) was touted as the miracle drug that a global medical conspiracy was colluding to keep away from the population – a claim made around evidence of similar quality as what is now being used for Ivermectin. If you recall, even certain world leaders brazenly supported the HCQ claims.

Stick to professional ideals and the science

Fortunately, science and the rigorousness of scientific procedures are dispassionate and remain consistent amid whatever emotional challenges that may be mounted against it.

The same steps were taken by global health institutions as they have taken now with Ivermectin i.e. institute clinical trials to determine the effectiveness of the drug and in this case, in every trial, it was proven ineffective, demoting HCQ to the dark chambers of forgotten pseudoscience.

The irony of the whole situation is that most of those who are now champions of Ivermectin and who pooh-pooh the lack of scientific rigour and data as being inconsequential are almost the same people who were very concerned about every single step of Covid-19 vaccine development, and its efficacy and safety.

They did not hesitate to question every possible side effect of every single vaccine, deep-dive into every single study and clinical trial and voice their doubts at every single opportunity; and even share on every single social media platform every single hypothetical scenario that may possibly have a remote chance of arising from the use of any Covid-19 vaccine even at the genomic level.

Why the double standard?

As healthcare professionals, we must be guided by the highest ideals of our profession and the need to stay true to the foundation of our scientific knowledge and training.

The moment we ourselves begin to cast doubt and aspersion on this; as well as to support moves to dismantle this effective framework which has ensured to the best of its ability the health and well-being of all people – we risk losing the identity and mantle of that we hold most dear- our calling as scientific professionals. - FMT

The views expressed are those of the writer and do not necessarily reflect those of MMKtT.